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Medicaid Fraud Control Unit

Mission

The Medicaid Fraud Control Unit’s (MFCU) mission is to protect the integrity of the Medicaid program and the safety and property of  the citizens of the State of Utah through skilled detection, proactive investigation, prevention, prosecution, and financial recovery.

Objectives

  • Prosecute providers in violation of Utah law
  • Stop or prevent the loss of Medicaid funds attributable to fraud, waste, or abuse
  • Recover Medicaid funds lost to fraud, waste, or abuse
  • Make recommendations to prevent fraud, waste, and abuse from recurring in the Medicaid system

Examples of Fraud

  • See also the False Claims Act (see Utah Code Ann. §26-20-1, et seq.)
  • Billing for services not rendered
  • Intentionally billing for services at a rate higher than allowed
  • Billing for ineligible patients
  • Financial exploitation of vulnerable adults
  • Pharmaceutical-related cases
    • Unlawful prescribing or dispensing of controlled substances
    • Actions by the drug manufacturers that are fraudulent

Abuse & Neglect

Abuse or neglect occurs when a caregiver knowingly causes physical harm or fails to provide needed services or protection to a patient.

The Utah Attorney General’s Office’s Medicaid Fraud Control Unit investigates and prosecutes patient abuse and neglect cases when the caregiver is paid through the Medicaid program. The Office is also authorized to investigate abuse or neglect of patients residing in board and care facilities, regardless of the payment source.

Contact us by calling 801-281-1259

 


SafeUT

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Take me to the University Neuropsychiatric Institute (UNI) SafeUT website

DOWNLOAD THE MOBILE APP TODAY on Apple and Google Play Stores

Utah Attorney General Sean Reyes, Utah State Senator Daniel Thatcher and representatives from the University of Utah Neuropsychiatric Institute (UNI), Utah Office of Education, and the School Safety and Crisis Line Commission unveiled the SafeUT Crisis & Safety Tipline for Utah students in 2016. The SafeUT Mobile App provides students confidential and anonymous two-way communication with SafeUT crisis counselors or school staff via one-touch options to “Call Crisisline,” “Chat Crisisline,” or “Submit a Tip.” Students using the mobile app will connect directly to a UNI crisis counselor at the UNI CrisisLine and those calling will be routed to the same. For those who do not have access to a smart phone, the Lifeline number 1-800-273-8255 is also supported by UNI.

“Statistics devastatingly show that suicide is the number one cause of death of Utah children ages 10-17. In addition, our schools and communities are facing crisis-level safety concerns,” said Attorney General Sean Reyes. “Because of such alarming realities statewide, our office has worked closely and in a very bipartisan manner with legislators, agencies, parents and advocates to find the right solution. Today, we unveil the SafeUT mobile app for 24/7 crisis intervention and emotional support to any student facing mental health crisis or safety threats. We are both excited about and hopeful that such a resource will provide a lifeline to students who feel they have nowhere else to turn and that life is not worth living anymore.”

After studying the issue, the Utah Attorney General’s Office and Senator Thatcher proposed legislation in 2014 to form a commission to explore solutions. The legislation passed and the commission was led to the University Neuropsychiatric Institute (UNI), already renowned for their excellence in crisis call support. In 2015, the School Safety and Crisis Line (SB 175) sponsored by Sen. Daniel Thatcher and Rep. Steve Eliason passed the Utah State Legislature designating UNI as the crisis provider and an active commission, chaired out of the AG’s office, for implementation. Senator Thatcher chose to sponsor the legislation after recognizing the statewide epidemic that had personally impacted him numerous times throughout his life.

“I was 11 years old the first time I lost a classmate to suicide, and at the age of 16, I lost one of my closest friends,” said Senator Thatcher.  “Every Utahn has felt the impact of suicide. It is the single deadliest crisis facing our youth. This commission and the work we have done is the only answer big enough to solve this problem. This is the hope our kids have been waiting for and I am deeply grateful to be part of such a comprehensive and collaborative effort which has created the SafeUT mobile app where an anonymous chat, text or call could save your life or the life of someone you love.”

Students can download the SafeUT Mobile app at any time – and will receive training on how to use SafeUT Services by their school administrators.  The first round of Utah school administrators were trained over the past six months on school implementation. Utah schools are currently participating or will have the opportunity to participate over the next year, but it is not mandatory. As schools enroll in the program, an online tool will be shared to allow students to report crisis or crime through their school’s website.


AG Hosts Human Trafficking Survivor & Healthcare Provider Focus Group

Attorney General’s Office Coordinates Research Effort with Human Trafficking Expert Dr. Laura Lederer That Will Add Utah Statistics to National Research Study & Training

SALT LAKE CITY Jan. 11, 2016 – Victims of human trafficking often go unnoticed and the crime unreported, despite interactions with various types of healthcare providers. In an effort to build awareness of human trafficking among prosecutors, investigators, and Utah’s health care community, the Utah Attorney General’s Human Trafficking Task Force will host two focus groups involving healthcare providers and human trafficking survivors on January 27, 2016. The Utah focus group session results will add Utah statistics to a national study underway that will support policy and program recommendations for healthcare providers to enhance their roles as identifiers of trafficking victims.

The Health Consequences of Human Trafficking and their Implications for Health Care Providers is a national study undertaken by Global Centurion Foundation President Laura Lederer, J.D., a subject matter expert on human trafficking for several U.S. government agencies. The study interviewed 107 sex trafficking survivors in 11 cities across the U.S. and found 99.1 percent had physical health problems and 98 percent had mental health problems.  The study also found that 87.8 percent had contact with a health care provider while they were trafficked.

Additionally, Attorney General Sean Reyes, the Office of the Utah Attorney General’s Human Trafficking Task Force and the National Association of Attorneys General (NAAG) plan to host a tuition-free, one and one-half day training for prosecutors and investigators on human trafficking. This training will take place on January 28 and 29 in Salt Lake City.

“This study humanizes victim suffering and provides common physical and mental health symptoms and other warning signs that can assist medical professionals in recognizing possible trafficking victims,” explained Attorney General Sean Reyes. “It also provides recommendations for new policy and programs, including training for health care providers, and suggestions for referral and reporting to help these victims of modern day slavery obtain broader criminal justice assistance.”

According to Lederer, “The hope is that this national study and the training that will come from it will enable prevention and improve interaction between healthcare providers and law enforcement to bring more perpetrators of this heinous crime to justice.”

Kathy Franchek, assistant professor of Pediatrics at the University of Utah School of Medicine, and Laura Lederer will lead the two focus groups scheduled to take place onJanuary 27 at Salt Lake County Government Center located at 2001 South State Street in Salt Lake City.

 

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AG Reyes and Team Package 15,000 Meals with Stop Hunger Now

Utah Office of the Attorney General & Stop Hunger Now Package 15,000 Meals for Charity

SALT LAKE CITY – Dec. 31, 2015 – Utah Attorney General Sean Reyes with his family and staff joined volunteers for Stop Hunger Now over the holidays to package 15,000 meals for charity. The event was hosted by the Utah Attorney General’s Office in the Utah State Capitol Rotunda on Dec. 22, 2015.

Since it’s founding in 1998, Stop Hunger Now has provided more than 200,000,000 meals and life-changing aid to 71 countries. In just under two hours, a group of 30 to 40 volunteers can package 10,000 nutrient-rich meals for the undernourished globally.

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National Attorneys General Training on Human Trafficking in SLC

National Attorneys General Training & Research Institute to Host Human Trafficking Training in Salt Lake City

Registration Deadline January 15, 2016 

SALT LAKE CITY – Dec. 21, 2015 – Utah Attorney General Sean Reyes is pleased to announce that the National Attorneys General Training & Research Institute (NAGTRI) of the National Association of Attorneys General (NAAG) is conducting a tuition free, one and one-half day training for prosecutors and investigators on human trafficking. The training will take place on January 28 — 29, 2016, at the Salt Lake City Council Chambers. Attendance is limited to prosecutors and investigators – and attendees must submit their registration by January 15, 2016.

“We are very excited to partner with the National Association of Attorneys General to provide this innovative, high quality trafficking disruption training,” said Attorney General Reyes. “One of our goals is to help build a network of local, national and international experts to eradicate the evils of human trafficking in Utah and around the world. This is not a uniquely Democrat or Republican issue, it is a humanitarian issue — a health and safety issue that needs everyone’s support to be effective. The best chance we have of combating this is to continue to work together.”

“We support Attorney General Reyes’ commitment to fighting human trafficking,” said Chris Toth, NAAG Deputy Executive Director and NAGTRI Director. “This NAGTRI training will ensure that Utah’s law enforcement will have the knowledge and tools necessary to rescue victims and to investigate and prosecute these crimes.”

The first day of training will include an overview of human trafficking; an introduction to the international, national and state legal frameworks for trafficking in persons; partnership models; victim issues; investigatory and interviewing techniques; and prosecutorial theories and practices. The second day will include a discussion on prosecutorial theories and practices, a case-study based ethics discussion and a workshop on developing a human trafficking prosecution.

While tuition-free, attendees will be responsible for paying for their own food, parking, and transportation expenses. The Attorney General’s Office will provide lunch on January 28. There will be a limited number of scholarships for hotel accommodations at the Sheraton Salt Lake City Hotel, provided to those who live more than 50 miles away.

For more information and to register please visit https://attorneygeneral.utah.gov/featured-content/human-trafficking-training.

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Attorney General Reyes Visits Mexico City, Strengthens Partnerships on Criminal Justice Issues

 

Focus on Joint Cross-Border Efforts to Combat Human Trafficking, Drug Trafficking & Internet Crimes

SALT LAKE CITY – Oct. 26, 2015 – Attorney General Sean Reyes recently helped lead a delegation of state attorneys general from the United States to Mexico City, Mexico, as part of a criminal justice conference focused on improving coordinated law enforcement efforts to combat human trafficking, drug trafficking, counterfeiting and internet security crimes. Last year, Reyes hosted his Mexican state counterparts along with the federal Attorney Generals of Mexico and El Salvador for similar training in Park City, Utah, as part of a program funded by the U.S. State Department at no cost to state taxpayers. His team will also conduct an online legal training this November for colleagues around the world.

“In today’s global environment, the definition of a ‘border state’ has been greatly expanded not only in terms of trade and economy – but also crime,” said Attorney General Reyes. “Criminal elements in Mexico smuggle drugs, people and counterfeit products into the U.S. while money and weapons are smuggled back into Mexico. Criminals from the U.S. are often complicit in these illicit activities whether or not they are from states that share a physical border with Mexico. The more we work with law enforcement partners in Mexico and other Latin American countries to improve information sharing and training for investigations and prosecutions, the greater the likelihood we can take criminals off the streets in our respective nations.”

The Binational State Attorney General Exchange was hosted by the Conference of Western Attorneys General (CWAG) Alliance Partnership and funded by the U.S. State Department. Attorney General Reyes’ participation was at no cost to the Utah taxpayer. The conference was attended by seven other U.S. state attorneys general, 26 Mexican state attorneys general and Mexico’s federal Attorney General Arely Gomez Gonzalez.

“I spent some very productive one-on-one time with General Gonzalez discussing legal issues and human trafficking – and this investment will result in greater protections for the citizens of Utah,” added Reyes.

Attorney General Carlos Zamarripa Aguirre of the Mexican State of Guanajuato stated, “Utah and the United States have a strong leader and great lawyer in Sean Reyes,” noting also that Reyes’ bilingual skills are an asset to the training program.

In addition to specific criminal topics, the U.S. attorneys general spent significant time training their Mexican counterparts on the nuts and bolts of criminal prosecution and defense issues as Mexico undergoes an overhaul of its’ criminal justice system. Pursuant to a 2008 Amendment in the Mexican Constitution, Mexico is transitioning away from an inquisitorial trial system to an adversarial one like that seen in the United States. The U.S. delegation was hosted at the Mexican Supreme Court where former Ambassador and now Supreme Court Justice Eduardo Medina Mora implored the delegation to continue helping Mexico.

“Eduardo is an old friend and we’ve worked together for years on economic and education issues – and it’s exciting to now work on justice reform together, “said Reyes. “What they are undertaking in Mexico is Herculean and if we can help them more quickly establish a stable adversarial system in which their citizens can start to have faith, it will help both countries. Mexico will benefit for obvious reasons and we benefit because of improved collaboration in jointly fighting crime.”

The highlight of the conference for Attorney General Reyes was a tour of a heavily guarded secret sanctuary for survivors of human trafficking. The Mexican government has made a priority of counseling, therapy, training and long-term resources for survivors of trafficking – some of whom are key witnesses in large trafficking cases.

“I was very impressed by the facility as a ‘sanctuary or safe house’ model and I look forward to further evaluating how we might be able to create such a facility to better help trafficking survivors in Utah and the United States,” said Reyes.

Attorney General Reyes was invited to return to Mexico this week to lead a U.S. Delegation to the United States-Mexico Chamber of Commerce Mexico Cumbre de Negocios Business Summit – and to speak on human trafficking and the Rule of Law in the Mexican justice transition. Other event speakers include Mexican President Enrique Peña Nieto and former Israeli President and Prime Minister Shimon Peres. Reyes will be unable to participate due to pressing cases in Utah, but thanks the hosts for the invitation.

“I’m flattered to be invited to lead a U.S. delegation to an event featuring the President and former Prime Minister of these great nations, but there’s always a balance my first priority is to the critical work of protecting Utah and its citizens and I’m needed here more this week.” concluded Reyes.

Utah AG Reyes Mexico 3Utah AG Reyes Mexico 2

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Attorney General Sean Reyes Delivers Keynote at the National Association of Women Judges 2015 Conference

Speech Highlights Women in Law & Utah’s Efforts to Combat Human Trafficking

SALT LAKE CITY Oct. 9, 2015 – Utah Attorney General Sean Reyes today delivered the keynote address at the National Association of Women Judges 2015 Conference, the 37th annual event held this year in Salt Lake City. Approximately 150 women judges from throughout the country and world representing federal, state, tribal, military and administrative law courts at both the appellate and trial levels were in attendance – along with many local practicing attorneys and law students.

“I want my little girl to grow up knowing she can achieve her dreams in part because you have pushed open many doors for generations of women behind you,” noted Reyes in his remarks. “And I want to thank you for making the fight against human trafficking, which ravages women and children worldwide, one of your organizational priorities.”

Utah has become a leader in combating trafficking both domestically and internationally. In addition to Utah’s universities offering programs focused on the issue, its legal and judiciary community, along with the legislature, non-profits network, corporations and law enforcement are joining together through the Trafficking in Persons Task Force administered through the Utah Attorney General’s Office.  Attorney General Reyes recently hosted 23 international leaders in trafficking discussions, trained 20 Attorneys General from foreign states and countries – and has been invited to speak with ambassadors and heads of state about coordinating efforts on this issue.

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U.S. Supreme Court Grants Utah’s Petition for Writ of Certariori in Utah v. Strieff

Oct. 1, 2015 – The U.S. Supreme Court today granted Utah’s petition for a writ of certiorari in Utah v. Strieff.  In Strieff the Court will address a Fourth Amendment issue important for day-to-day police work: whether evidence seized incident to a lawful arrest on an outstanding warrant should be suppressed because the warrant was discovered during an investigatory stop that was later found to be just shy of the requisite reasonable suspicion.  The U.S. Supreme Court will review the Utah Supreme Court’s January 2015 decision holding that the district court should have suppressed drug evidence found on Edward Joseph Strieff, Jr. after he was lawfully arrested by police on an outstanding warrant.

“Strieff’s arrest on an outstanding warrant was an intervening circumstance that justifies use of the evidence at trial – and we welcome the U.S. Supreme Court’s review of this matter,” said Attorney General Sean Reyes.

“The U.S. Supreme Court grants only about 75 of the more than 10,000 petitions for a writ of certiorari it receives each year,” added Utah Solicitor General Tyler Green, a former U.S. Supreme Court clerk. “The Court’s grant in Strieff is a testament to the first-rate work of the attorneys in the Criminal Appeals Division of the Utah Attorney General’s Office who prepared the petition, including Assistant Attorney General Jeffrey S. Gray, who was counsel of record for the petition.”

In December 2006, police received an anonymous tip that drugs were being sold out of a South Salt Lake residence. Detective Doug Fackrell conducted intermittent surveillance of the home over the course of a week. After observing some short-term visitors coming in and out of the residence that was consistent with drug activity, Detective Fackrell stopped Strieff as he left the home to question him about his activities there. During the stop, Detective Fackrell discovered that Strieff had an outstanding warrant and arrested him. In a lawful search incident to arrest, Detective Fackrell found methamphetamine and a drug pipe in Strieff’s pockets.

Strieff moved to suppress the evidence on the grounds that the officer lacked reasonable suspicion of criminal wrongdoing. Although the district court concluded that Detective Fackrell was mistaken in his belief that he had enough evidence to conduct the brief, investigatory stop – it ruled that the ensuing arrest on a warrant justified admission of the drug evidence in a trial for possession methamphetamine and drug paraphernalia. The Utah Court of Appeals agreed, but the Utah Supreme Court reversed.

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